College of Naturopathic Medicine

Cultivating tomorrow’s physicians to empower patients and communities through the integration of traditional, innovative, and evidence-informed naturopathic medicine.

Naturopathic Medicine

Naturopathic medicine is a primary care approach to health and wellness that focuses on restoring and optimizing health. It is a distinct system of health care—an art, science, philosophy and practice of diagnosing, treating and preventing disease. This art of natural healing has deep roots in ancient history and developed during the eighteenth and nineteenth centuries from the German hydrotherapy movement. This new art was nurtured by medical as well as non-medical practitioners into rigorous hospital- and spa-based practices that were ultimately practiced worldwide. Natural healing developed incrementally and has been shaped and refined in the United States since the beginning of the 20th century.

Traditional naturopaths embrace the belief that health is influenced by each individual’s inherent healing ability. In this paradigm of vitalism, disease is viewed empirically as a direct result of ignoring or violating the general principles of health. Practitioners aim to correct and stabilize these environments as their primary interventions to ward off disease. Modern naturopathy can be viewed as an evolving system of practices that bridge elements of conventional, alternative and traditional medical practices to enhance an individual’s self-healing processes and support wellness. Naturopathic physicians are clinically trained, licensed primary care physicians who have graduated from an accredited postgraduate four-year naturopathic medical school. They work with patients in all aspects of family health to identify the underlying causes of disease and provide evidence-informed therapies to help facilitate the body’s ability to restore and maintain optimal health.

A Brief History: Naturopathic Medicine in the U.S. and NUNM

Drs. Benedict and Louisa Lust brought “nature cure” medicine from Europe to the United States in 1896 and helped develop the term naturopathy. Benedict Lust is widely credited for establishing naturopathic medicine in North America. However, the important contributions of Louisa Lust in establishing naturopathy are less well-known. Born Aloesa Strobele, Louisa was a financially successful business woman and the physician in charge of the Bellevue Sanitarium, a prominent nature cure spa in Butler, New Jersey, before she met and then hired Benedict as chief medical director—and financed the first naturopathic college. Together they renamed the Bellevue as Yungborn, where they advanced nature cure. NUNM honors both Lusts as the architects of naturopathic medicine in North America.

By the early 20th century, naturopathic medicine was flourishing throughout the country. Naturopathic doctors were licensed in a majority of states. There were more than 20 naturopathic medical colleges; the most prominent was Lust’s American School of Naturopathy in New York City. Naturopathic medical conventions at that time attracted more than 10,000 naturopathic physicians.

At the same time, there was strong support emerging for what is now known as conventional or allopathic medicine. The Flexner Report of 1910 was commissioned through the Carnegie Foundation as a critical examination of medical education in the United States and Canada. Its goal was to lend credence to the standardization of medical education admissions, licensing and practice. It ultimately led to radical reforms in medical education and training.

Abraham Flexner, who graduated from John’s Hopkins University with a Bachelor of Arts degree, was the founder of an experimental high school and was known to be critical of the American education system. He eschewed all medical approaches that he deemed lacking in scientific research and validity. Naturopaths, in particular, came under greater scrutiny as the allopathic medical profession questioned the viability of naturopathic medicine. Pressure to close naturopathic schools and eliminate the profession began to gain momentum.

Naturopathic medicine experienced a precipitous decline in the 1940s and ‘50s with the emergent rise of pharmaceutical medicine and technological advances. The concept that Flexner introduced, that naturopathic medicine was quackery or charlatanism, became prevalent. Naturopathic licensing was largely discontinued. Schools either complied with the call to eliminate curricula for naturopathy or closed their doors.

From NCNM to NUNM

As the last naturopathic degree program was terminated at Western States College of Chiropractic and Naturopathy in Portland, Oregon, naturopathic doctors banded together to find a way to save the profession from extinction. NDs from around the country raised money to create a school they would fight to keep open for generations to come. In 1956, Drs. Frank Spaulding, W. Martin Bleything and Charles Stone signed incorporation papers, establishing National College of Naturopathic Medicine (NCNM) in Portland, Oregon. From its founding until 1979, NCNM was the only naturopathic medical college in North America.

Established by those who began practicing in the 1920s and ‘30s, NUNM (first known as National College of Naturopathic Medicine, more recently as National College of Natural Medicine, and now as National University of Natural Medicine) has been at the center of the profession for more than 60 years, preserving and extending the legacy of naturopathic medicine by educating and training future physicians.

Since 1998, the profession has experienced resurgence and tremendous growth as an increasingly health-conscious public sought alternatives for conditions that conventional medicine does not adequately address. This growth is in direct response to the changing needs of our society. The public is demanding a medical model in which the individual plays a more active role in their own health and healing process; naturopathic doctors want a practice that is more patient-centered and holistic. This convergence of needs, and the beneficial healthcare outcomes that patients experience from naturopathic treatment, has led to the increasing popularity of naturopathic medicine. At the same time, more state legislatures are approving licensure for naturopathic medicine.

Today, NUNM is alma mater to thousands of naturopathic physicians. Our graduates practice in a rapidly growing number of U.S. states, territories, Canadian provinces and foreign countries. Many are nationally acclaimed healthcare experts, as well as successful physicians. Since 1956, when a determined group of NDs launched a new era in naturopathic education, NUNM alumni have forged new pathways that fundamentally improve the health of our communities on a national scale, and in doing so they are advancing the naturopathic profession. This is an exciting time to join the profession and continue making history in the field of naturopathic medicine.

Scope of Practice

Naturopathic physicians’ scope of practice varies by jurisdiction. Currently, 26 states, five Canadian provinces, the District of Columbia, and the U.S. territories of Puerto Rico and the U.S. Virgin Islands have laws regulating naturopathic doctors (NDs). Scope varies between states, including differences in pharmaceutical prescribing, minor surgery, IV & IM administration, diagnostic imaging/labs, and childbirth attending or midwifery. The jurisdictions that regard NDs as primary care physicians provide them with a diagnostic and therapeutic scope of practice. These include general and preventive health care, as well as diagnosis and treatment of acute and chronic conditions.

In jurisdictions where NDs are not regulated, the scope of practice flourishes as adjunctive care since the practices of diagnosis and treatment of disease tend to be excluded.

Licensing and Credentialing of Naturopathic Physicians

Naturopathic doctors are legally recognized to practice medicine throughout the United States and U.S. territories, Canada, as well as many other countries. NDs are licensed in: Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Pennsylvania, Utah, Vermont, Washington, Idaho, Rhode Island, New Mexico and Wisconsin. They are also licensed in Washington D.C., the U.S. territories of Puerto Rico and the Virgin Islands, and in the Canadian provinces of Alberta, British Columbia, Manitoba, Ontario, Nova Scotia and Saskatchewan. In other U.S. and Canadian jurisdictions, a varying scope of naturopathic practice may be permitted or protected by court decisions, attorney general opinions or local regulations. The best sources of current information about the legal status of naturopathic medicine in a particular area are the American Association of Naturopathic Physicians (naturopathic.org), state or provincial naturopathic associations, and individual naturopathic physicians practicing in those areas.

Currently, all states that license naturopathic physicians require graduation from a residential course of study offered through an accredited institution approved by the examining jurisdiction.

NUNM meets all requirements of, and is accredited by, the Council on Naturopathic Medical Education (CNME). Completion of the ND degree at NUNM qualifies candidates to sit for the national licensing examination—the Naturopathic Physicians Licensing Exam (NPLEX), which is a key requirement for licensure. Some jurisdictions have additional examinations, for example in Oregon, there are additional examinations in jurisprudence and prescribing formulary pharmaceuticals due to Oregon’s wider scope of practice. It is also routine for regulators to require a fingerprint-based national criminal history search.

Similar to other healthcare providers, recently graduated NDs are encouraged to seek additional clinical experience under the supervision of a licensed physician in the form of residencies and mentorships. It should be noted that the state of Utah requires a one-year residency before licensing NDs. In some states, insurers are showing credentialing preference to those with postgraduate residencies.

Residencies

NUNM is proud to lead the profession in developing and administering the first and largest accredited graduate medical education program. We now offer more than 60 accredited residencies. Our residency program is rigorous and competitive; it provides invaluable clinical experience to assist our graduates in completing the transition toward becoming practicing physicians. With established residency programs both locally and throughout the United States, we work with specialty providers and renowned hospitals—including an integrative rotations partnership with Oregon Health & Science University here in Portland, Oregon.

Educational Outcomes of the Program

• Medical Knowledge- Knowledge for Practice: Apply knowledge of normal human structure, function and development, from the molecular through whole body levels, to distinguish health from disease and explain how physiologic mechanisms are integrated and regulated in the body. 
• Patient Care & Procedures- Skills for Practice: Gather essential and accurate information about patients and their conditions through history taking, physical examination, review of prior data and health records, laboratory data, imaging and other tests.
• Effective Communication: Communicate effectively and professionally in both verbal and written communications with patients, peers, and the public across a broad range of socioeconomic and cultural backgrounds. 
• Ethics and Professionalism: Exemplify the professional values of naturopathic medicine. Demonstrate responsible behaviors expected of naturopathic physicians  
• Practice-Based Learning, Research and Scholarship: Utilize critical reflection on one’s own performance (knowledge, skills and attitudes) 

The Six Philosophical Principles of Naturopathic Medicine

The practice of naturopathic medicine emerges from six principles of healing. These principles are based on the objective observation of the nature of health and disease, and are examined continually in light of scientific analysis. These principles stand as the distinguishing marks of the profession:

First Do No Harm

primum non nocere

Therapeutic actions that are complementary to, and synergistic with, the body’s innate healing process reduce harm to patients. Naturopathic physicians follow three precepts to avoid harming the patient:

• Use methods and medicinal substances that minimize the risk of harmful effects, and apply the least possible force or intervention necessary to diagnose illness and restore health.
• Whenever possible, avoid symptom suppression as it can interfere with the healing process.
• Respect and cooperate with the vis medicatrix naturae in diagnosis, treatment and counseling.

The Healing Power of Nature

vis medicatrix naturae

The body has the inherent ability to establish, maintain and restore health. The healing process is ordered and intelligent; nature heals through the response of the life force. The physician’s role is to facilitate and augment this process, to identify and remove obstacles to health and recovery, and to support the creation of a healthy internal and external environment.

Identify and Treat the Cause

tolle causam

Illness does not occur without cause. Underlying causes of disease must be discovered, and removed or treated, before a person can recover completely from illness. Symptoms are expressions of the body’s attempt to heal, but are not the cause of disease; therefore, naturopathic medicine primarily addresses the underlying causes of disease, rather than the symptoms. Causes may occur on many levels, including physical, emotional, mental and spiritual. The physician must evaluate fundamental underlying causes on all levels, directing treatment at root causes as well as seeking relief of symptoms.

Treat the Whole Person

in perturbato animo sicut in corpore sanitas esse non potest

Health and disease are conditions of the whole organism, involving a complex interaction of physical, spiritual, mental, emotional, genetic, environmental and social factors. The physician must treat the whole person by taking all of these factors into account. The harmonious functioning of all aspects of the individual is essential to recovery from and prevention of disease, and requires a personalized and comprehensive approach to diagnosis and treatment.

The Physician as Teacher

docere

Beyond an accurate diagnosis and appropriate prescription, the physician must work to create a healthy, sensitive interpersonal relationship with the patient. A cooperative doctor-patient relationship has inherent therapeutic value. The physician’s major role is to educate and encourage the patient to take responsibility for their own health. The physician is a catalyst for healthful change, empowering and motivating the patient to assume responsibility. It is the patient, not the doctor, who ultimately creates or accomplishes healing. The physician must strive to inspire optimism as well as understanding. The physician must also make a commitment to their personal and spiritual development in order to be a good teacher.

Prevention

principiis obsta: sero medicina curatur

The ultimate goal of naturopathic medicine is prevention of disease. This is accomplished through education and promotion of lifestyle habits that foster good health, and through secondary prevention modalities, including those promoted by the U.S. Preventive Services Task Force. The physician assesses risk factors and hereditary susceptibility to disease, and counsels patients on methods to avoid further harm and risk. The physician places the greatest emphasis on building health. Because it is difficult to be healthy in an unhealthy world, it is the responsibility of both physician and patient to create a healthier environment in which to live.

Diagnostic Techniques

NDs are trained in diagnostic techniques, such as physical exam, laboratory testing, diagnostic imaging and psychological assessment. NDs endeavor to identify disease states in the context of the individual’s overall health.

Therapeutic Techniques

Botanical Medicine: Many plant substances are powerful medicines. Where isolated, chemically derived drugs may address only a single problem, botanical medicines are able to address a variety of problems simultaneously. When properly administered, most botanical medicines can be applied effectively with minimal chance of side effects.

Clinical Nutrition: Food is the best medicine and is a cornerstone of naturopathic practice. Many medical conditions can be treated effectively with foods and nutritional supplementation, with fewer complications and side effects. NDs use diet, fasting and nutritional supplementation in their practices.

Homeopathic Medicine: Homeopathic medicine is the treatment of disease/symptoms using correctly prescribed, minimal doses of natural substances (plant, animal, mineral), which, if taken in larger doses, would cause disease/symptoms—the acting principle being “like cures like.” It promotes the return to health on physical, mental and spiritual levels.

Mind-Body Medicine: Mental attitudes and emotional states may influence or even cause physical illness. Counseling, nutritional balancing, stress management, and other therapies are used to help patients heal psychologically.

Minor Surgery: Naturopathic physicians perform in-office minor surgery, including repair of superficial wounds and removal of foreign bodies, cysts and other superficial lesions.

Naturopathic Natural Childbirth/Midwifery: Trained and licensed naturopathic physicians facilitate natural childbirth in an out-of-hospital setting. They offer prenatal, intrapartum and postpartum care using modern diagnostic techniques combined with ancient midwifery wisdom. NUNM offers an elective course sequence resulting in a Natural Childbirth/Midwifery Certificate that allows students to apply for separate licensure in naturopathic natural childbirth.

Pharmaceutical Medicine: While naturally derived pharmaceutical drugs have been within the scope of naturopathic practice in Oregon for decades, in 2009 state legislation expanded the formulary and licensed naturopathic physicians may use most prescription pharmaceutical agents commonly employed in a primary care setting. The law become effective January 2010. Consistent with our conventional counterparts, and depending on the individual licensing laws of each state, naturopathic physicians may utilize a wide formulary of pharmaceutical medications when deemed appropriate for patient care—and always in consideration of our naturopathic principles.

Physical Medicine: Naturopathic medicine utilizes therapeutic manipulation of soft tissue, muscles, bones and spine. NDs also use ultrasound, diathermy, exercise, massage, water, heat and cold, and other gentle electrical therapies in the treatment of musculoskeletal conditions and pain.

Parenteral Therapy: Intravenous and intramuscular injections of micronutrients and macronutrients are used for many purposes, from simple nutritional support to detoxification procedures in cases of exposure, and specific treatment of both chronic and acute diseases.

Nature Cure: The use of time-honored natural treatments including fresh air, exercise, whole foods and hydrotherapy are important in the naturopathic treatment and prevention of disease.